MEDICARE: MR. BABU PHILIP LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R050903-1	NY

General Provider Information

NPI Number	:	1588731830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BABU PHILIP LCSW

Provider Business Mailing Address
First Line	:	295 SAINT JOHNS PL
Second Line	:	3J
City	:	BROOKLYN
State	:	NY
Zip	:	11238-5650
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	UPPER MANHATTAN MENTAL HEALTH CENTER, 1727 AMSTRDM AVE
Second Line	:	CHEMICAL DEPENDENCE SERVICES, 3RD FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10031
Country	:	US
Telephone Number	:	212-694-9200
Fax Number	:	212-694-4619

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	11/20/2009

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